| Background:Non-invasive prenatal testing(NIPT)has been widely used in clinical practice due to its safety and accuracy in the screening of common chromosome aneuploidy in fetus.NIPT analyzed the risk of trisomy 21,trisomy 18 and trisomy 13 in fetuses by detecting cell-free DNA(cfDNA)in the peripheral blood of pregnant women.The source of cfDNA is not unique,and its content varies depending on maternal age,activity,environment and disease.Maternal peripheral blood cfDNA not only includes maternal source cfDNA but also contains cell free fetal DNA.Maternal source cfDNA mainly comes from the DNA fragments released by maternal cell apoptosis and necrosis,while cell free fetal DNA mainly comes from the release of placental cell apoptosis.Existing studies have found that there is a certain correlation between cfDNA content and adverse pregnancy outcomes,which may be due to changes in cfDNA content caused by related pathophysiological changes,but such research has not been conclusive,especially in the population of assisted reproductive pregnancy,need further Research confirms that there is an inevitable connection between the two subject.Objective:This study aims to explore the correlation between the content of cfDNA in early pregnancy and adverse pregnancy outcomes in the assisted reproductive pregnancy population,with a view to predicting the occurrence of disease before the disease progression,early diagnosis and treatment,and improve the adverse pregnancy outcomes in the relevant population.Materials and methods:This study collected the clinical data of 13302 pregnant woman with a single pregnancy who successfully got pregnant through assisted reproductive technology in the affiliated reproductive hospital of Shandong university from March 2015 to December 2018 and received NIPT test at 11+0 to 13+6 weeks gestation for retrospective analysis.According to pregnancy outcome,the patients were divided into gestational hypertension(HDP)group,gestational diabetes mellitus(GDM)group,premature delivery(PB)group,and control group(without adverse pregnancy outcome mentioned above),including 11142 patients in the control group,688 patients in the HDP group,1004 patients in the GDM group and 791 patients in the PB group.Compare the basic data such as age,weight,body mass index(BMI),tested gestational age,gestational age,assisted reproductive methods,and neonatal weight of the four groups,and analyze the differences in cfDNA content between the four groups,using the binary logistic regression model to analyze whether cfDNA content is the independent predictor of adverse pregnancy outcomes.Results:1.CfDNA levels in the HDP group(6.95±3.62 ng/ml),GDM group(6.65±4.26 ng/ml)and PB group(6.55±3.83 ng/ml)were higher than those in the control group(6.32±3.38 ng/ml).Differences in cfDNA values between the HDP group and the GDM group were statistically significant(P?0.01).However,there was no significant difference in cfDNA value between PB group and control group(P=0.067).2.BMI,embryo transfer type and cfDNA concentration were independent risk factors for HDP(OR=1.203,95%CI:1.148-1.262,P=0.000;OR=0.707,95%CI:0.594-0.841,P=0.000;OR=2.841,95%CI:1.541-5.237,P=0.001,respectively).Weight was an independent protective factor for HDP(OR=0.981,95%CI:0.964-0.998,P=0.033),and age was not an independent risk factor for HDP(P>0.05).3.Age,weight and BMI were independent risk factors for GDM(OR=1.071,95%CI:1.055-1.086,P=0.000;OR=1.017,95%CI:1.002-1.032,P=0.026;OR=1.061,95%CI:1.018-1.105,P=0.005,respectively),cfDNA concentration,the cause of infertility,and the mode of assisted reproduction were not independent risk factors for GDM(P>0.05).4.Age and BMI were independent risk factors for PB(OR=1.026,95%CI:1.009-1.043,P=0.002;OR=1.149,95%CI:1.098-1.203,P=0.000),weight and fresh embryo transplantation were independent protective factors for PB(OR=0.973,95%CI:0.957-0.990,P=0.002;OR=0.841,95%CI:0.719-0.983,P=0.029).5.Age and cfDNA concentration were independent risk factors for LBW(OR=1.024,95%CI:1.003-1.046,P=0.025;OR=2.107,95%CI:1.018-4.357,P=0.044,respectively),and the number of embryos transferred was an independent protective factor of LBW(OR=0.770,95%CI:0.613-0.968,P=0.025).Conclusions:1.CfDNA concentration at 11+0 to 13+6 weeks of gestation may have certain predictive value for HDP or LBW in the population of assisted reproductive pregnancy,higher cfDNA concentration is associated with an increased risk for HDP or LBW.2.CfDNA concentration increased in LBW and GDM,but after adjusting for relevant factors,the value of cfDNA in predicting LBW and GDM in the population of assisted reproductive pregnancy at 11+0 to 13+6 weeks was limited.3.CfDNA concentration at 11+0 to 13+6 weeks of pregnancy in the population of assisted reproductive pregnancy has no definite predictive value for PB. |
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